Healthcare Provider Details

I. General information

NPI: 1639937881
Provider Name (Legal Business Name): DANIEL SCOTT PINCUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 35
CLIFFWOOD NJ
07721-1512
US

IV. Provider business mailing address

352 EVERGREEN DR
BRICK NJ
08723-4924
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-2555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAD-GTL-22-02782
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: